About Us

Skin Biospy Services

About Skin Biopsy Services

There are currently over 100 different types of rheumatic conditions. Some of these are degenerative like osteoarthritis, but the majority are caused by autoimmune processes. Some of these include lupus and rheumatoid arthritis.

These autoimmune diseases often times affect the skin, nails, and mucosal membranes. A skin biopsy can be an important and crucial diagnostic and prognostic marker. The Center for Rheumatology is offering skin biopsy services from Dr. Jessica Chapman. Please schedule your appointment today.

If a rash is suspected of being caused by a rheumatologic condition, we are equipped to evaluate the potential underlying condition AND quickly perform any necessary skin biopsy on site.

Conditions and Diseases

Rheumatology and the Skin

Autoimmune diseases often affect multiple organ systems, including the skin. Some of these include:

Scleroderma

Calcinosis cutis

Morphea, also called localized scleroderma

Systemic lupus erythematosus

Cutaneous lupus

Dermatomyositis or polymyositis

Mixed connective tissue disease

Vasculitis

Raynaud’s

Sarcoidosis

Psoriasis with severe arthritis

Panniculitis

Eosinophilic fasciitis

Neutrophilic dermatoses

Rheumatology and the Nervous System

At times, the nervous system may also be affected by autoimmune diseases. Some conditions like lupus and sarcoidosis can affect the brain. But many other conditions can affect the small nerve fibers that supply the skin. This is called small fiber neuropathy.

Small fiber neuropathy results from damage to the small, unmyelinated nerve fibers that transmit pain and temperature and control autonomic functions like sweating.

Often times, small fiber neuropathy can be missed with traditional nerve conduction tests. Recently a new test that measures the density of the nerve fibers has been developed and validated. It involves obtaining two small 3 mm skin biopsies.

Services

Skin Biopsy

At times, a skin biopsy may be necessary to make a diagnosis.

What is a punch biopsy?

A punch tool about the size of a pencil eraser is used to obtain a sample of skin.

This helps the pathologist look at all the layers of the skin: epidermis, dermis, and hypodermis/subcutaneous tissue.

This is the most common technique.

What is a shave biopsy of skin?

An instrument that looks like a razor is used to remove a small sample of skin.

It is often used to remove superficial lesions or raised lesions like vesicles and bullae.

Epidermal Nerve Fiber Density Testing

What is Small Fiber Neuropathy? Small fiber neuropathy results from damage to the small, unmyelinated nerve fibers that transmit pain and temperature and control autonomic functions like sweating.

Nerve fiber density testing is an objective test. It can provide peace of mind, documentation for diagnostic tests and treatments, and differentiate between different types of neuropathy.

It’s been estimated that 30 – 40% of patients diagnosed with fibromyalgia using the American College of Rheumatology diagnostic criteria, actually suffer from small fiber neuropathy.

Common symptoms of small fiber neuropathy:

Numbness

Tingling

Burning

Stinging

Hypersensitivity to pain

Testing for small fiber neuropathy involves two small 3 mm skin biopsies. The skin is numbed with lidocaine and epinephrine and then a 3 mm piece of skin is removed using a punch instrument. Sutures may be required.

The specimen is then sent to a board certified pathologist who will then examine, measure, and count the nerve fibers.

Testing for Small Fiber Neuropathy

Testing for small fiber neuropathy involves two small 3 mm skin biopsies. The skin is numbed with lidocaine and epinephrine and then a 3 mm piece of skin is removed using a punch instrument. Sutures may be required.

The specimen is then sent to a board certified pathologist who will then examine, measure, and count the nerve fibers.

***Patient Instructions

***Information we provide on www.joint-docs.com and any other source or links from our site is not intended to provide medical advice. Information on this website is not a substitute for professional medical advice. Use of this site does not establish a doctor patient relationship. To diagnose or treat a health problem, for questions regarding a medical condition, or prior to starting any new treatment, you should consult with a qualified healthcare provider. For medical matters, please contact your doctor’s office by telephone. In emergency situations, call 911.

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Testimonials

I have been a patient of this practice for 28 yrs. and I feel that I am MOST fortunate to have received the very best care and treatment available. I have not enough words to express my appreciation, fondness and respect for Dr. Joel Kremer.

Dr. Toledo goes above and beyond for her patients. She treated me like a human being and not just another patient. She actually made eye contact with me, which so many other practitioners do not. I am very impressed with Dr. Toledo-Garcia!

I think Dr. Michaels is awesome. She spent so much time with me. She is really personable and not what I expected at all. Looking forward to seeing her again. I loved her tips!

I would recommend Dr. Shapiro and his nurse practitioner without any reservation whatsoever. I am extremely lucky to have Dr. Shapiro as my rheumatologist and that he has chosen over the years to continue to accept me as a patient. He is so professional, knowledgeable, trustworthy and kind.

I would recommend Dr. Hausner to anyone. She is a wonderful doctor. She listens to me and responds to my concerns/needs. She is compassionate, caring and very good at her job.

Dr. Greenstein has been my rheumatologist for 30 years. I couldn't imagine where my disease would be today without his knowledgeable, kind intervention and treatment! He literally has given me my life back.

I have been very impressed with Dr. Faisal Chaudhary. He is very knowledgeable and willing to listen to and discuss complementary strategies as well.

I have and continue to recommend your practice to anyone looking for a rheumatologist. Dr. Cavaliere is very caring and really takes the time to listen and best of all really makes appropriate changes to help my overall pain level.

I will continue to recommend your office because of my excellent visit with Rhonda Murphy, RPA and I will continue to request her. I learned so much about my different problem areas from her. She was so informative. It really was one of the best doctor visits I've ever had.

I definitely would recommend the practice. I have been seeing Mari Kaymakcian for over 3 years now and she is very thorough and understanding of my problems.

Your new office is gorgeous, accommodating and so pleasant to visit! It makes having to go to the doctor a pleasurable experience.

Dr. Cosgrove and her team give me peace of mind dealing with our medical problems in such a calm, cheerful and highly professional manner.